Wine Versus Grape Juice

Everyone knows that pregnant women aren’t supposed to drink. Some bars won’t even serve a mother-to-be. Such precautions are taken out of respect and responsibility for the unborn child about to enter the world. We see this in the media – a once social drinker politely refusing a drink, smiling and saying “I’m not drinking, I’m pregnant”, receiving a series of “oohs” and “aahs” by an awed audience. Perhaps this predictable scene speaks to the miracle of life which gives cause for celebration. More often than not, the choice to abstain from alcohol is exactly that – a choice. No one is forcing them to trade in that relaxing glass of wine for orange juice – it is a personal, maternal decision, the first true act of selflessness.

When this choice is regarded as a novelty and the mother does not exercise self-restraint, the consequences can be fatal. The transfer of alcohol through the umbilical cord to the developing fetus can result in what are known as fetal alcohol spectrum disorders, or FASDs whose symptoms range from irreversible physical to mental to behavioural abnormalities (abnormal facial features, learning disabilities, intellectual deficit, hyperactive behaviour etc) or even death (Sudden Infant Death Syndrome). The most common of the fetal alcohol spectrum disorders is known as foetal alcohol syndrome (FAS), a condition in which the child is born with problems with their central nervous system, and have issues in both the academic and social aspects of school. Such aberrations can be prevented with the complete abstinence from alcohol consumption during pregnancy. Simple enough, right?

There are many reasons why a mother-to-be may choose to continue drinking during pregnancy. Considerable duress, addiction or even being unaware of the developing embryo due to an unplanned pregnancy all may factor into such decisions, but the consequences are severe. Then again, is it not the personal choice of the individual whether she can or cannot consume just a glass of wine or pint of beer now and then during the 9 month period? Is it not her body and thus her decision to make?

The severity of the FASDs and the utter unfairness to the newborn child has resulted in propositions that a law should be put in place to criminalize substance abuse by pregnant women. In passing such a bill, the concept of personal autonomy is painstakingly cast aside in an effort to provide the child with the best possible quality of life, free from unnecessary bullying and lifelong frustrations.

This calls into question that extent to which the mother is responsible for the child’s life and the extent to which she is free to make her own decisions. On one hand, the child is a helpless, innocent being, wholly dependent and completely at the mercy of his/her human host and hence the substances being consumed, but on the other hand the mother is an independent individual who has the legal rights to chug some beer or enjoy a cigarette after a stressful day if she so chooses. Unfortunately, the outcome for both of these considerations are mutually exclusive.

Countries which favour the former over the latter will incarcerate or impose punitive legal actions against such women. In the U.S, three states – Alabama, South Carolina and Tennessee have criminalized substance abuse during pregnancy. Others will turn a blind eye and silently pray for the developing fetus. Often there are no specific laws regarding this matter, however many states have been reported to prosecute women for substance abuse.

We now call into question the role of healthcare professionals in all this. They are the ones who will be most likely to detect significant substance abuse, especially addiction, in pregnant women either via trusting patients who confide in them or simple biomedical tests. They should thus be trained in the way to approach such patients regarding their substance abuse and be able to communicate the unique requirements of pregnant women to improve perinatal and neonatal outcomes. Like they say, education is the best way to break the cycle, and information regarding the severe adverse effects of substance abuse during pregnancy will likely appeal to most mothers to be. Ultimately, I believe this training is the most important large scale change that should be made, rather than the focus on legalities.

As much as we like to think that the laws that govern us are steadfast and the people in our community are law-abiding citizens, the contrary may be true. No one can force a person to start or stop doing something, for the long term anyway. In this case, it is in the best interests of both the mother and the unborn child for the mother to receive a basic medical education on substance abuse and its impacts, and simply leave her to make her decision, because in the end, she’s going to be the one that makes it anyway.